Provider Demographics
NPI:1184993818
Name:GORDON, ASHANTIA HOLIZA (PCA/CNA)
Entity type:Individual
Prefix:MISS
First Name:ASHANTIA
Middle Name:HOLIZA
Last Name:GORDON
Suffix:
Gender:F
Credentials:PCA/CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2439
Mailing Address - Country:US
Mailing Address - Phone:860-993-2399
Mailing Address - Fax:
Practice Address - Street 1:490 TOLLAND ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2502
Practice Address - Country:US
Practice Address - Phone:860-281-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide